Celiac Disease and Mental Health: Anxiety

Anxiety: What is it? Do anxiety disorders affect many people?

Anxiety is considered a reaction to stress. It helps an individual handle a tense and stressful situation. It is the body’s way of helping a person cope and react to stress. However, when anxiety becomes excessive and irrational, it is considered a disorder. Anxiety disorders affect about 40 million American adults age 18 years and older and cause people to become consumed with fearfulness, worry and uncertainty. In contrast to mild, brief anxiety caused by a stressful event (i.e. first date, first day on a new job), generalized anxiety disorders last for at least 6 months and can worsen if the symptoms are not treated (APA, 2000, p. 476). Anxiety disorders may occur with depression, which may heighten either the anxiety symptoms, depressive symptoms, or both (NIMH, 2011).

Are there different types of anxiety disorders?

According to the American Psychiatric Association (2000), there are several types of anxiety disorders. Some common ones found in people with celiac disease include:

Generalized Anxiety Disorder (GAD) - GAD involves excessive worry and tension, even when there are very few triggers that may cause anxiety. The worry is abundant and interferes with daily life. A person may worry over numerous situations or things (i.e. work, diet, family, finances, friends, future), and it feels uncontrollable and at times, debilitating.

Obsessive Compulsive Disorder (OCD) - OCD involves uncontrollable thoughts (obsessions) and rituals (compulsions). A common example is a person with an uncontrollable thought of and fear of germs, causing them to perform rituals to ease their anxiety around germs. This person may compulsively was his or her hands when dealing with these thoughts.

Panic Disorder - Individuals with panic disorder have feelings of intense terror or fear that comes without warning. They experience a panic attack, which means that they may have chest pain, excessive sweating, or feel like they are choking.

Social Phobia - This involves an overwhelming sense of worry and self-consciousness in social situations. The worry is focused on being judged by others or being in a situation that may cause embarrassment or ridicule.

Specific Phobias - A specific phobia is an intense fear of a specific object or situation. Examples include an intense fear of flying or heights. The fear is considered inappropriate to the situation, and the individual may go to extreme measures to avoid situations that involve the object or situation.

What are the symptoms of anxiety disorders?

According to the National Institute on Mental Health (2011), anxiety symptoms vary depending on the type of disorder (i.e. GAD, OCD), but the general symptoms that indicate an anxiety disorder may be present include the following:

Uncontrollable worry or nervousness

Uncontrollable, obsessive thoughts

Ritualistic behaviors

Feelings of uneasiness or fear

Repeated thoughts of traumatic events, flashbacks

Problems sleeping

Shortness of breath

Increased heart rate

Difficulty relaxing

Numbness, tingling sensations in the hands and/or feet

Nausea

Muscle tension

Dizziness

Anxiety in individuals with celiac disease

Individuals with celiac disease face a number of stressors before and after diagnosis.

Undiagnosed celiac population:

Individuals with celiac disease often report symptoms of anxiety, nervousness, or irritability prior to diagnosis. These feelings are related to gastrointestinal issues, fatigue, and insomnia, as well as worrying about their health. Similar to depression, nutrition deficiencies resulting from malabsorption have a role in anxiety. For example, a deficiency in B vitamins, calcium, magnesium, and amino acids have been found to trigger anxiety related symptoms (Leyse-Wallace, 2008).

Research on the association between celiac disease and the prevalence of anxiety disorders prior to diagnosis is unclear. Most research focuses on depressive symptoms in celiacs. In addition, there are conflicting results about the presence of anxiety prior to diagnosis. Anxiety, as well as depression, can be experienced by any individual at any point in time due to different stressors and life situations. While individuals report having anxiety symptoms prior to diagnosis, it is hard to determine if the anxiety is related to the celiac disease, life events, or a combination of the two. Interestingly, a German study published in June 2010 found no association between anxiety and the duration of the gluten-free diet. However, an Italian longitudinal study reported a decrease in anxiety after initiating a gluten-free diet (Häuser et al, 2010). The results of the study suggest that some anxiety symptoms are present before diagnosis, and these symptoms tend to alleviate with the gluten free diet.

Diagnosed celiac population:

While many individuals with celiac disease often find diagnosis to be a relief, research has also found that diagnosed celiacs are at an increased risk for anxiety. The Italian longitudinal study found that women with celiac disease on a gluten-free diet reported higher levels of anxiety compared to women in the general population (Häuser et al, 2010). Similarly, a study published in June 2011 found that children with celiac disease following a gluten-free diet had higher rates of anxiety and depression compared to children who did not have celiac disease (Mazzone et al., 2011).

Like depression, anxiety in individuals with celiac disease is often related to the challenges of disease management. The constant attention to risks of cross-contamination can lead to phobias related to eating or dining out. Others may develop an obsessive compulsive disorder around cleaning surfaces or utensils before eating.

While researchers are beginning to recognize the association between celiac disease and anxiety, more research is needed to fully understand the relationship between these two conditions.

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